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Chapter 2: Insomnia

Life stressors are often at the root of an individual’s insomnia, such as: keeping a stressful and unhappy job, shift work, erratic schedule changes on weekends, inactivity following retirement, and co-sleeping with disruptive bed partners. Unless these issues are identified and addressed, the insomnia is unlikely to be resolved.

Good sleep habits are practices that foster and maintain good sleep health. They involve a variety of behaviors and conditions that can be consciously changed to improve an individual’s quality and quantity of sleep.

No universally accepted list of good sleep habits exists, but Table 2.2 presents common rules to promote good sleep health, and the rationale for each rule1.

Patients with chronic insomnia may benefit from following some of the sleep-health techniques. The key to successful therapy is to tailor the approach to the individual and to begin by emphasizing only one or two sleep rules. Additional or alternative sleep-health rules can be considered if there is no improvement in sleep quantity or quality within a few weeks.

It is important to note, however, that people with chronic insomnia actually have better sleep habits than those without insomnia2. This is likely because the former are already familiar with the easy methods for treating insomnia and have implemented these techniques. Any sleep habit approaches should be carefully tailored to the individual’s situation and needs.

Table 2.2: Sleep hygiene rules1

Rule

Rationale

Curtail time in bed

Excessive time in bed can lead to fragmentation of sleep by frequent awakenings, shallow sleep (more stage 1 and 2, less SWS), and non-restorative sleep.

Keep a regular sleep schedule

Getting up and going to bed at consistent times help stabilize the circadian rhythms and entrain the person to a 24-hour sleep-wake cycle.

Remove the bedroom clock.

Watching the clock can lead to frustration, worry, and arousal.

Exercise in the afternoon/early evening.

If exercise occurs within 4-6 hours of going to bed, it may shorten the onset of sleep. Exercising in the afternoon or early evening may increase slow wave sleep.

Avoid caffeine, nicotine, and alcohol, especially in the afternoon

These substances all disturb sleep. Caffeine and nicotine are stimulants, while consuming alcohol in the evening causes frequent awakenings during the night.

Adjust your bedroom environment to enhance sleep comfort

A quiet, dark and cool bedroom is conducive to sleep. Noise and light may cause a person to wake up, and light impacts the circadian rhythms. Sleep on a comfortable mattress.

Avoid “trying” to sleep

Anxiety and actively trying to force sleep promotes arousal. Reduce anxiety and worry with a relaxing activity such as reading or breathing exercises.